Impact of immediate feedback on the learning of medical students in pharmacologyDINESHBADYALDepartment of Pharmacology, Christian Medical College, Ludhiana, IndiaauthorSUMANBALADepartment of Pharmacology, Himalayan Institute of Medical Sciences, Dehradun, IndiaauthorTEJINDERSINGHDepartment of Pediatrics, Christian Medical College, Ludhiana, IndiaauthorGAURAVGULREZDepartment of Pharmacology, Christian Medical College, Ludhiana, Indiaauthortextarticle2019engIntroduction: Providing feedback to students is an essentialcomponent in medical education and has been shown to improvethe students’ learning. The purpose of this study is to evaluatethe effect of computer-based immediate feedback on the medicalstudents’ learning in a pharmacology course.Methods: In this prospective intervention study some feedbackmodules in pharmacology (FMP) were prepared in two topics:the cardiovascular system (CVS) and chemotherapy, using blanktemplates on “Hot Potatoes” software. The FMP included MCbasedquestions and two versions were developed: one withfeedback (FMP-1) and the other without feedback (FMP-2). TheFMP-1 module provided immediate feedback for each option thestudent chose. The students (n=48) were randomized by computergenerated random number table to two groups A and B to receivethe module in CVS, i.e., FMP-1 and FMP-2, respectively. A crossoverdesign was adopted to expose all students to immediatefeedback modules. The test scores were compared and feedbackwas obtained from students and faculty using a validatedquestionnaire. A focus group discussion was conducted to clarifythe issues raised by the students.Results: The module with immediate feedback was much betterappreciated by the students than the module without feedback.The students spent more time on FMP-1 (42±7.00 minutes vs27±12.36 minutes; pJournal of Advances in Medical Education & ProfessionalismShiraz University of Medical Sciences7

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201916http://jamp.sums.ac.ir/article_41036_6ceac5250772870c757a457925f42ffb.pdfdx.doi.org/10.30476/jamp.2019.41036Assessing clinical reasoning skills using Script Concordance Test (SCT) and extended matching questions (EMQs): A pilot for urology traineesSYEDNAZIM1Section of Urology, Department of Surgery, The Aga Khan University Hospital, Karachi, PakistanauthorJAMSHEERTALATISection of Urology, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan.authorSHEILAPINJANIDepartment for Educational development, The Aga Khan University Hospital, Karachi, PakistanauthorSYED RAZIUDDINBIYABANI SSection of Urology, Department of Surgery, The Aga Khan University Hospital, Karachi, PakistanauthorMUHAMMADATHERSection of Urology, Department of Surgery, The Aga Khan University Hospital, Karachi, PakistanauthorJOHNNORCINIFoundation for Advancement of International Medical Education and Research (FAIMER), Philadelphia, Pennsylvania, United States of Americaauthortextarticle2019engIntroduction: Clinical reasoning skill is the core of medicalcompetence. Commonly used assessment methods for medicalcompetence have limited ability to evaluate critical thinking andreasoning skills. Script Concordance Test (SCT) and ExtendedMatching Questions (EMQs) are the evolving tests which areconsidered to be valid and reliable tools for assessing clinicalreasoning and judgment. We performed this pilot study to determinewhether SCT and EMQs can differentiate clinical reasoning abilityamong urology residents, interns and medical students.Methods: This was a cross-sectional study in which an examinationwith 48 SCT-based items on eleven clinical scenarios and four themedEMQs with 21 items were administered to a total of 27 learners atthree differing levels of experience i.e. 9 urology residents, 6 internsand 12 fifth year medical students. A non-probability conveniencesampling was done. The SCTs and EMQs were developed fromclinical situations representative of urological practice by 5 contentexperts (urologists) and assessed by a medical education expert.Learners’ responses were scored using the standard and the graduatedkey. A one way analysis of variance (ANOVA) was conducted tocompare the mean scores across the level of experience. A p-valueofJournal of Advances in Medical Education & ProfessionalismShiraz University of Medical Sciences7

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2019713http://jamp.sums.ac.ir/article_41038_059db585fc03776a7716e7aee68acea9.pdfdx.doi.org/10.30476/jamp.2019.41038Online-learning: exploring practices among Foundation doctorsFLORENCEKASHORA1Core Surgical Trainee/CT2, University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester LE1 5WW, UKauthorDEBBIE-ANNECHARLESConsultant, General Medicine/Endocrinology, Queen Elizabeth Hospital Woolwich, London, SE18 4QH, UKauthortextarticle2019engIntroduction: Postgraduate medical education involves the use ofonline-learning tools. However, there is a paucity of data on theuse of online-learning among doctors who are in their 1st and 2ndyears of professional work after graduating from medical school(also known as Foundation doctors). Our aim was to explore theuse of online-learning among Foundation doctors.Methods: A cross-sectional study was carried out, usingconvenience sampling. During one month, 66 Foundationdoctors from across 2 district hospitals and 1 teaching hospital inSoutheast England filled out a specially designed questionnaire.Data were collected and analyzed using Microsoft Excel™, and reported in numbers and percentages.Results: The majority of Foundation doctors (86.4% (n=57))reported using online-learning packages. These are the toolswhich consist of key information on a particular topic, and maybe interactive and broken down into several smaller modules.Less than half embarked on online-learning in their 1st month ofemployment, with a decline in the numbers who started in thelater months. Of those who reported completing online-learningpackages, 57.9% (n=33) reported completing non-compulsorymodules, 66.7% (n=38) reported completing a range of 0-15modules per week, and 75.4% (n=43) completed the moduleswithout skipping components. More Foundation doctors reportedusing online-learning for lifelong learning (63.6% (n=42)) andfilling knowledge gaps (51.5% (n=34)) than improving theirpractice following a mistake (24.2% (n=16)). Additionally, onlinelearningwas used less frequently than medical websites or searchengines, for the aforementioned purposes.Conclusion: Most Foundation doctors use online-learning, butthis needs to be incorporated into their postgraduate learningactivities earlier in their career and directed more towardsimproving their clinical practice.Keywords: Cross-sectional studies, Education, Distance, Hospitals, TeachingJournal of Advances in Medical Education & ProfessionalismShiraz University of Medical Sciences7

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20191419http://jamp.sums.ac.ir/article_41040_9be5ed06606e28dad6abaaaa35fed158.pdfdx.doi.org/10.30476/jamp.2019.41040Analysis of Iran’s National Medical Education Evolution and Innovation Plan using the Michelle and Scott’s model of policymakingATAPOURABBASIEndocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, IranauthorHAMIDAKBARIDepartment of Pharmaceutics, Faculty of Pharmacy, Tehran University of Medical Science, Tehran, IranauthorAMIRAKHVANSchool of Public Health, Tehran University of Medical Sciences, Tehran, IranauthorALI AKBARHAGHDOOSTModeling in Health Research Center, Institute for
Futures Studies in Health, Kerman University of Medical Sciences, Kerman, IranauthorZAHRAKHEIRYInnovation Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, IranauthorREZADEHNAVIEHHealth Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, IranauthorHAMEDRAHIMIDeterminants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, IranauthorSOMAYEHNOORI HEKMATHealth Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, IranauthorBAGHERLARIJANIEndocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iranauthortextarticle2019engIntroduction: Lack of a clear policy for the development of healthhuman resources has created inconsistencies. These imbalancesare threats to the health system to achieve its goals. Therefore, thedevelopment of human resources through proper performance ofhigher education health system is an important part of the policydevelopment process of the health sector. The present paper aimsto introduce the methods applied for the compilation of evolutionand innovation program of medical sciences training as well asthe most important directions for evolution and innovation.Methods: In this study, we evaluated the methodology fordesigning packages of Iran’s higher education health systemevolution and innovation. For this purpose, the evaluation of thepolicy process was conducted based on Michelle and Scott’s policyprocess models. This policy evaluation model starts by problemidentification and definition and continue by agenda setting, policyformation, legitimation, implementation, evaluation, and policymodification, using the proper feedback. Qualitative contentanalysis method was used as a research method for subjectiveinterpretation of the content of the text data.Results: Twelve policies, 68 strategies and their translation in thehealth system were adopted in a comprehensive plan for higherhealth education. Eleven practical packages were also developedin order to implement these policies as packages for reform andinnovation in medical education. These packages were organizedbased on the IPOCC pattern.Conclusion: The lack of a comprehensive look at each projector program could bring about irreparableness consequences.However, the MoHME of Iran, relying on the integration of healthhigher education with health care system and comprehensivemethod used for transformation and innovation plan in the fieldof health higher education could take an important step towardsimproving the nation’s health.Keywords: Health, Medical education, Manpower, Policy, EvolutionJournal of Advances in Medical Education & ProfessionalismShiraz University of Medical Sciences7

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20192026http://jamp.sums.ac.ir/article_41041_5e7352775f7a549e0d6aa3c39da412ca.pdfdx.doi.org/10.30476/jamp.2019.41041Exploration of faculty members’ perceptions about virtual education challenges in medical sciences: a qualitative studyMOHAMMADKESHAVARZIMedical Education Department, Faculty of Medicine, CERMS (Center of Educational Research in Medical Sciences), Iran University
of Medical Sciences, Tehran, IranauthorSEYED KAMRANSOLTANI ARABSHAHIMedical Education Department, Faculty of Medicine, CERMS (Center of Educational Research in Medical Sciences), Iran University
of Medical Sciences, Tehran, IranauthorBANAFSHEHGHARRAHEEDepartment of Clinical Psychology, School of Behavioral Sciences and Mental Health (Tehran
Institute of psychiatry), Iran University of Medical Sciences, Tehran, IranauthorZOHREHSOHRABIMedical Education Department, Faculty of Medicine, CERMS (Center of Educational Research in Medical Sciences), Iran University
of Medical Sciences, Tehran, IranauthorMARJANMARDANI HAMOOLEHDepartment of Psychiatric Nursing, Faculty of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iranauthortextarticle2019engIntroduction: Virtual education is among the important factorsimproving the learning of medical students. This study aimed toexplain the perceptions of faculty members towards the challengesof virtual education.Methods: The present study was carried out with a qualitativeapproach and using a conventional content analysis method.The participants included 28 faculty members working inMedical universities in Iran who were purposefully recruited andinterviewed face to face practicing semi-structured interviews.All interviews were conducted and reviewed; then, the resultswere extracted. For this purpose, semantic similarities werefirst measured and subcategories identified. Subsequently, goingthrough the re-review, we grouped the associated subcategoriesinto wider categories.Results: From the analysis of the participants’ narratives, twowide categories including organizational barriers and legalethicalchallenges were obtained. The organizational barriersincluded two subcategories of defective organizational cultureand disproportionate infrastructure. The legal-ethical challengesalso included subcategories of neglecting intellectual propertyrights and ignoring ethical actual instances in the field of virtualeducation.Conclusion: Understanding the challenges to which virtualeducation implementation is faced leads to their eliminationwhich, in turn, develops the application of e-learning in the fieldof medical sciences. These challenges can be addressed throughputting the emphasis on promoting the organizational cultureof medical universities, improving the infrastructures of virtualeducation, and considering the legal and ethical concepts specificto virtual education.Keywords: Education, Learning, Technology, Medical educationJournal of Advances in Medical Education & ProfessionalismShiraz University of Medical Sciences7

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20192734http://jamp.sums.ac.ir/article_41042_f047f5674d1d34d2f309bf882cede311.pdfdx.doi.org/10.30476/jamp.2019.41042The influence of role-modeling on the clinical empathy of medical interns: A qualitative studyNAHIDAHMADIAN YAZDICenter For Educational Research in Medical Sciences (CERMS), Iran University of Medical Sciences, Tehran, Iran; Department of
Medical Education, Faculty of Medicine, Iran University of Medical Sciences, Tehran, IranauthorSHOALEHBIGDELICenter For Educational Research in Medical Sciences (CERMS), Iran University of Medical Sciences, Tehran, Iran; Department of
Medical Education, Faculty of Medicine, Iran University of Medical Sciences, Tehran, IranauthorKAMRANSOLTANI ARABSHAHICenter For Educational Research in Medical Sciences (CERMS), Iran University of Medical Sciences, Tehran, Iran; Department of
Medical Education, Faculty of Medicine, Iran University of Medical Sciences, Tehran, IranauthorSAEIDEHGHAFFARIFARMedical Education Research Center, Health
Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iranauthortextarticle2019engIntroduction: Clinical empathy ascertains the quality of doctorpatientrelationship and entails beneficial outcomes for bothparties. Role-modeling is a major factor in promoting clinicalempathy skills of medical students. The present study attemptedto explain the importance of role-modeling in clinical empathy ofmedical interns. It was also intended to obtain a better and moreprofound understanding of the subject based on the experiencesof medical interns.Methods: In this qualitative conventional content analysis, semistructuredindividual interviews were conducted with 14 medicalinterns and 6 clinical professors. The participants were selected bypurposive sampling. All interviews were recorded, transcribed,and analyzed. Trustworthiness, credibility, and confirmability ofthe data were confirmed.Results: Data analysis led to the emergence of a theme called rolemodeling,and two subcategories: “advertent role-modeling” and“inadvertent role-modeling”. Advertent role-modeling included“influenced by the charismatic personality of professors”, “critiqueof faculty members’ communicative behaviors with patients”, and“observation of the faculty members’ performance”. Inadvertentrole-modeling included “crystallization of human values incommunication behaviors” and “compliance with hierarchicalbehavior”.Conclusion: Role-modeling was the main theme of the presentstudy. To improve clinical empathy skills, particular attentionshould be paid to role-modeling. Informing clinical professorsand medical students on role-modeling, strengthening students’empathetic behaviors by role model professors, and recruitmentof professors with strong communication skills are among therecommended strategies of this study.Keywords: Medical students, Empathy, Role-modeling, Qualitative studyJournal of Advances in Medical Education & ProfessionalismShiraz University of Medical Sciences7

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20193541http://jamp.sums.ac.ir/article_41043_3c381e22127717a49954de406a3422f3.pdfdx.doi.org/10.30476/jamp.2019.41043Good, bad and ugly: Exploring the Machiavellian power dynamics of leadership in medical educationDINESHKUMAR VDepartment of Anatomy, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Indiaauthortextarticle2019engIntroduction: Medical education requires participation of variousstakeholders and this contributes to power dynamics operating atmultiple levels. Personality traits of an individual can affect thesmooth execution of the educational programmes and eventuallythe professionalism of the environment. With the increased focuson leadership traits in medical education and collaboration inhealth care settings, I, through this commentary, would like toexplore the Machiavellian power dynamics involved and how itcan influence the harmony prevailing in an organization.Methods: The author has tried to review the several aspects ofMachiavellianism in health care settings and describe day-to-dayexperiences at four levels; micro (individual), meso (departmental),macro (institutional) and mega (discipline). Introspecting on theunaddressed issues in a different light would help to gain a deeperunderstanding regarding work place ethics and professionalism.Results: The reflection of day-to-day experiences in a differentperspective would provide an insight regarding various issuesto health professionals and help in developing ethical leadershipabilities in them, which eventually promulgates professionalism.Conclusion: To my best knowledge, this is the first commentaryto deal with the implications of Machiavellianism in differentissues related to health care settings. With the increased emphasison the leadership traits related to medical education, analysingorganizational issues in various dimensions is of paramountimportance.Keywords: Leadership, Machiavellianism, Professionalism, Organizational dynamicsJournal of Advances in Medical Education & ProfessionalismShiraz University of Medical Sciences7

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20194246http://jamp.sums.ac.ir/article_41035_8d93355143359c4afdfa8881c074d519.pdfdx.doi.org/10.30476/jamp.2019.41035Change as an opportunity - Collaborative research in a fluctuating global landscapeMICHAELMAHGEREFTEHFaculty of Medicine, Imperial College London, Level 2, Faculty Building, South Kensington Campus, London, SW7 2AZ, UKauthorNIKHILMATHFaculty of Medicine, Imperial College London, Level 2, Faculty Building, South Kensington Campus, London, SW7 2AZ, UKauthorAVIKORMANFaculty of Medicine, Imperial College London, Level 2, Faculty Building, South Kensington Campus, London, SW7 2AZ, UKauthortextarticle2018engDear Editor, We note with great enthusiasm the advancesto the medical field that have been broughtabout by international collaboration betweenmedical researchers in different countries.Collaboration occurs when “2 or more entitieswork together to produce a desired and sharedoutcome” (1). Literature on the topic notesspecifically the strategic alignment of globalpartnerships with global health priorities, (2)and how international collaboration advancesthese goals through research teams workingtogether on such projects. Indeed, it is not onlyin research, but also in medical practice andeducation where important strides are oftenmade by observing and importing the healthcareand education practices of other countries (3).The medical community in Iran hascontributed admirably to the global advancementof medicine. According to the Scopus index, in2015 Iran ranked first for the number of scientificpapers published and number of citations, bothin its region and among all Islamic countries (4).Furthermore, the research ranking of IranianUniversities has been consistently high andimproving over time (5).However, in a constantly fluctuating globallandscape, it may become increasingly difficultfor Iranian institutions to maintain internationalcollaborative efforts over time, and to buildnew ones. With the introduction of US travelrestrictions for Iranians (amongst others), travelto the US for conferences, research projects,observerships, etc. have become significantlymore problematic (6). Naturally, this is likely tonegatively affect the Iranian medical communityin its efforts and advancements. The networksand connections made at international meetingsthroughout the world can act as a gateway tocollaborative projects and research. In reducingthe capacity for Iranian scientists to involvethemselves, there is an inherent risk to thecapacity for progression of medical research andpractice in Iran.Considering the value of the Iranian medicalcommunity and the challenges it faces, we urgestrengthening of the efforts for collaborationamong its scientists and medical practitionersand the rest of the world. An opportunity existsfor ties to be formed and relationships to bestrengthened where they previously were weakor non-existent. At Imperial College London,we note wholeheartedly the many members offaculty and frontline medical staff who havecome from Iran, bringing tangible advances totheir specialist fields. We believe there is now achance to reinforce this scientific relationship.Cross-collaboration through medical conferences,mutual travel grants to other countries, andactive participation of scientists and cliniciansof Iranian descent can all be utilised to fortifythis relationship. One particular aspect that maybe used is the strength of Iran within medicalbiotechnology (7). Moreover, partnershipsin newer fields, such as remote healthcareprocedures and services, represent anotherchance to overcome the difficulties in travel facedby Iranian scientists.Journal of Advances in Medical Education & ProfessionalismShiraz University of Medical Sciences7

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20184748http://jamp.sums.ac.ir/article_41037_bc437f51608b5dee45d10b9126065fb5.pdfdx.doi.org/10.30476/jamp.2018.41037A one-day visit of the EEG and EMG/NCV departments during neurology course for medical students of Shiraz University of Medical SciencesMARYAMPOURSADEGHFARDClinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, IranauthorALIREZANIKSERESHTNeurology Department, Shiraz University of Medical Sciences, Shiraz, Iranauthortextarticle2019engDear editor Today, an important part of the patients’diagnostic activities includes paraclinicaltests and procedures, which follow theircompleted history-taking and clinicalexaminations, in such a way that many medicalscience sources in different fields considerthem to be follow-up activities of clinicalexaminations. This is also the case in the field ofneurology and many of its specialized subfields.For example, in a patient suspected of seizureand epilepsy, an EEG not only helps to identifythe real patient’s problem or disease, but also todiagnose the type of the disease and contributesto decision-making on the type of the drugto use. The EMG/NCV is also necessary forpatients with a possible peripheral neuropathicinvolvement. In most cases, paraclinicalactivities are performed outside the educationalsettings, such as in laboratories or specialprocedure rooms, and students, residents andlearners are only informed about the results ofthose activities without observing how they areactually performed, so they will not learn thatdiagnostic method and will not gain a deepunderstanding of it, to the point that they may beunfamiliar with the necessity of doing that evenduring their practice. This leads in many casesto unnecessary requests or its postponementin essential conditions. Unfortunately, theabove-mentioned problem is found among bothstudents and residents. Moreover, we foundfew appropriate and useful studies in this areadue to the learners’ unfamiliarity with thisscientific area and their lack of interest andmotivation for research in this regard. For theabove reasons, the educational deputy of theNeurology Department of Shiraz University ofMedical Sciences decided to solve this problemthrough a new training course. During the aboveeducational process, the sixth year studentsof medicine in Shiraz University of MedicalSciences, who are receiving training during theirone-month course of neurology, were dividedinto groups of six to eight members, and eachgroup, together with a resident, visited the EEGand EMG/NCV departments of Imam RezaClinic affiliated to Shiraz University of MedicalSciences as a tour lasting for a few hours outsidethe clinical departments and listened to a fulldescription from doctors, personnel and otherprofessionals in these departments. In addition,they closely visited the patients as well as thedevices used in these departments.Investigations show that different units ofmedical education at Iranian universities ofmedical sciences have regularly been visited,but no periodical and regular visits have beenperformed as part of a predetermined curriculum.However, a relatively similar study conducted atShiraz University of Medical Sciences in 2017reported that holding a short-term (one day anda half) practical laboratory training course couldsignificantly increase the students’ experienceand training (1).Other published studies have been in theform of short-term training courses in thelaboratory or pathological sciences rather thanone-or-two-day visits. However, these studies aresimilar to our educational process in that bothare held during a short term with the aim of thestudents’ further familiarity and readiness. Forexample, a study was conducted on fourth-yearmedical students, in which a one-and-a-half-daycourse was designed to familiarize the studentswith paraclinical methods and help them gainexperience in this regard. The results of thisstudy showed that this one-day course was agreat incentive for the training of some selectedparts of medical education (2). Another study wascarried out in 1987 on medical students, showingthat the students’ preliminary familiarity withthe clinical stages can be very effective if thesestages are held in short terms, in small groups,and with a focus on basic issues (3).The Neurology Department of ShirazUniversity of Medical Sciences hopes to achievethe following goals by implementing the abovementionedtraining course:1. Understanding of the above-mentionedprocesses better by attending the patients’ bedsideand observing the processes closely,2. Familiarizing the students with the reasonsfor requesting each of the two above-mentionedprocedures to prevent unnecessary requestsduring the future years of practice,3. Motivating and encouraging the studentsto study the related subjects better and moreaccurately,4. Encouraging the students to do research ineach of the two above-mentioned areas,5. Familiarizing the students with the difficultyof work and possible problems when doing theabove-mentioned investigations and taking theminto consideration in future years of practice, and6. Familiarizing them with the personnel andusing their experiences.Journal of Advances in Medical Education & ProfessionalismShiraz University of Medical Sciences7